Rupture of Ectopic Ovarian Pregnancy Accompanied by Massive Intra-abdominal Bleeding and Disorder of the Coagulation Mechanism: A Rare and Life-Threatening Obstetric Complication

Abstract

The rupture of ectopic ovarian pregnancy accompanied by massive intra-abdominal bleeding is a rare obstetric complication, occurs predominantly in the first trimester of pregnancy, and can be dangerous and life-threatening for the pregnant woman. Our case describes a 37yr old woman with a history of 4 lower segment Cesarian sections (LSCS) (Caesarean sections) and multiple surgical abortions, presenting at the ER with acute abdomen symptoms. The patient's hemodynamic status was unstable. The positive urine pregnancy test combined with the clinical and ultrasound findings established the diagnosis of the ruptured ectopic pregnancy, and immediate surgical treatment was decided. During surgery, a large amount of blood was found in the peritoneal cavity, resulting from a rupture of the right ovary and accompanied by hemorrhagic infiltration of adjacent tissues, without participation in the damage of the ipsilateral fallopian tube. It was deemed necessary to remove the ipsilateral adnexa and whole blood transfusion. The patient was discharged from our department on the fourth postoperative day. The price of beta-chorionic gonadotropic hormone was on a downward trend. Three weeks later, the level of beta-chorionic gonadotropic hormone was zero. In the present paper, a brief review is attempted regarding the diagnostic and therapeutic approach for patients with ruptured ectopic ovarian pregnancy after describing the case.

Unruptured Ovarian ectopic pregnancy in adolescence

“…In the operation, we used laparoscopic scissors to separate and remove the pregnancy lesions. Then sutured the ovaries with an absorbable suture [9,10].…”

Unruptured ovarian ectopic pregnancy: Two case reports and literature review

“…Although ovarian pregnancies in the second ( Hwang et al, 2020 ) or even third trimester of pregnancy ( Prabhala et al, 2015 ) have been reported, most ovarian pregnancies are found in the first trimester ( Thanasa et al, 2022 ; Huang et al, 2022 ). Most of the patients were treated because of abdominal pain or intraperitoneal hemorrhage secondary to ovarian pregnancy rupture.…”

A history of adnexal surgery and tuberculosis are risk factors for ovarian pregnancy following assisted reproductive technology: a retrospective matched case-control study

“…OP has been linked with a high incidence of circulatory collapse and hemoperitoneum, attributed to the fragility and hypervascularity of ovarian tissue [6]. Due to the lack of elasticity in the ovarian cortex, most OP rupture within the rst three months of pregnancy [7,8], with 5.3% occurring in the second trimester and only 3.7% occurring in the late trimester [9,10]. Thus, early identi cation of OP is of paramount importance.…”